血清胰岛素联合心脏相关标志物评估脓毒症 相关性脑病病情的意义  

Significance of serum insulin combined with cardiac markers in evaluating sepsis associated encephalopathy

作　　者：康霞艳 胥志跃[2] 袁远宏[2] 张新萍[1] 罗海燕[2] 范江花[2] 卢秀兰[2] 肖政辉[2] Kang Xiayan;Xu Zhiyue;Yuan Yuanhong;Zhang Xinping;Luo Haiyan;Fan Jianghua;Lu Xiulan;Xiao Zhenghui(Department of Pediatric Intensive Care Unit of Hunan Children's Hospital,Changsha 410007,China;Emergency Center,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院重症医学科,长沙410007 [2]湖南省儿童医院急救中心,长沙410007

出　　处：《中华急诊医学杂志》2023年第6期755-760,共6页Chinese Journal of Emergency Medicine

基　　金：湖南省卫生健康委科研计划课题(202106011318);湖南省科技创新重点工程项目(2020SK10141-3)。

摘　　要：目的探讨血清胰岛素联合心脏相关标志物评估脓毒症相关性脑病病情的临床价值。方法回顾性分析2018年1月至2021年12月入住儿童危重症监护病房的130例脓毒症患儿的临床资料, 比较脓毒症及脓毒症相关性脑病患儿血清胰岛素及心脏相关标志物水平的差异。结果脓毒症相关性脑病组患儿血清胰岛素水平、肌酸激酶同工酶、超敏肌钙蛋白、N末端脑尿肽水平均明显高于脓毒症非脓毒症相关性脑病组, 差异有统计学意义(P<0.05), 而心率、乳酸差异无统计学意义(P>0.05);死亡组患儿血清胰岛素水平、肌酸激酶同工酶、超敏肌钙蛋白、N末端脑尿肽、乳酸水平明显高于存活组, 差异有统计学意义(P<0.05), 心率差异无统计学意义(P>0.05);血清胰岛素、肌酸激酶同工酶、超敏肌钙蛋白、N末端脑尿肽在预测脓毒症相关性脑病方面, ROC曲线下的面积分别为0.841、0.599、0.700、0.667,;在判断脓毒症预后方面, ROC曲线下的面积分别为0.647、0.669、0.645、0.683;在判断脓毒症相关性脑病患儿预后方面, ROC曲线下的面积分别为0.509、0.682、0.666、0.555;以血清胰岛素、肌酸激酶同工酶、超敏肌钙蛋白、N末端脑尿肽建立二分类Logistic回归方程:Y=8.153×NT-proBNP+1.704×CTnT-hs+27.121×胰岛素+0.946×CK-MB+1.573, 新变量Y在预测脓毒症相关性脑病、评估脓毒症预后、预测脓毒症SAE患儿预后方面, ROC曲线下的面积分别为0.890、0.756、0.729。结论血清胰岛素、肌酸激酶同工酶、超敏肌钙蛋白、N末端脑尿肽可单独应用于判断脓毒症及脓毒症相关性脑病患儿的病情, 4项指标联合检测的评估价值明显优于单项指标, 4项指标联合应用可能更好的评估脓毒症及脓毒症相关性脑病病情。Objective To explore the clinical value of serum insulin combined with cardiacrelated markers in evaluating the severity of sepsis associated encephalopathy(SAE).Methods The clinical data of 130 children with sepsis who admitted to the Pediatric Intensive Care Unit of Hunan Children's Hospital from January 2018 to December 2021 were analyzed retrospectively,and the differences of serum insulin and cardiac-related markers in children with sepsis and SAE were compared.Results The levels of serum insulin,creatine kinase isoenzyme,hypersensitive troponin T,and N-terminal cerebral urine peptide in the SAE group were significantly higher than those in the non-SAE group(P<0.05),but there was no signifi cant difference in heart rate and lactic acid(P>0.05).The levels of serum insulin,creatine kinase isoenzyme,hypersensitive troponin T,N-terminal cerebral urine peptide and lactic acid in the death group were signifi cantly higher than those in the survival group(P<0.05),while the heart rate was not signifi cantly different(P>0.05).The area under ROC curve of serum insulin,creatine kinase isoenzyme,hypersensitive troponin T,and N-terminal cerebral urine peptide in predicting SAE were 0.841,0.599,0.7,and 0.667,respectively;in terms of judging the prognosis of sepsis,the area under ROC curve were 0.647,0.669,0.645,and 0.683,respectively;and in terms of judging the prognosis of children with SAE,the areas under the ROC curve were 0.509,0.682,0.666 and 0.555,respectively.Binary logistic regression equation was established with serum insulin,creatine kinase isoenzyme,hypersensitive troponin T,and N-terminal cerebral urine peptide:Y=8.153×NT-proBNP+1.704× CTnT-hs+27.121× insulin+0.946×CK-MB+1.573.The area under the ROC curve of the new variable Y in predicting sepsis SAE,evaluating the prognosis of sepsis,and predicting the prognosis of children with sepsis and SAE was 0.890,0.756,and 0.729,respectively.Conclusions Serum insulin,creatine kinase isoenzyme,hypersensitive troponin T,and N-terminal cerebral urine peptide can be

关 键 词：脓毒症相关性脑病 儿童 血清胰岛素 心脏相关标志物 

分 类 号：R720.597[医药卫生—急诊医学] R747.9[医药卫生—儿科]